Diagnostic and Therapeutic Difficulties in Carotid Body Paragangliomas, Based on Clinical Experience and a Review of the Literature

Abstract

which approximately 50% originate from the carotid body [4]. The carotid body was first described by von Haller in 1743 [5]. It mainly regulates pH, pO 2 and pCO 2 levels in the blood by registering changes in those parameters and transmitting them though the glossopharyngeal nerve Paragangliomas, also known as chemodectomas or carotid body tumors, are rare neuroendocrine tumors. They represent about 0.03% of all neoplasms and appear more frequently in women than men (1. Objectives. The aim of the study was to carry out an epidemiological and clinical analysis of paraganglioma patients diagnosed and treated at the authors' clinics between 1985 and 2014. Material and Methods. The medical data of 47 patients were analyzed. All the patients were qualified for surgery. In 43 cases (88%), simple resection of the tumor was performed, including 11 cases (22%) that additionally required vascular suturing, and 5 (10%) that required reconstruction of the internal carotid artery. Carotid vessel repair was performed by shortening the internal carotid artery in 3 cases (6%), using a saphenous vein graft in 2 cases (4%), and by creating an anastomosis between the external carotid artery and the distal portion of the internal carotid artery in one case (2%). Results. In 40 cases (82%), the course of treatment was uneventful. Three patients (6%) were reoperated because of symptoms of cerebral stroke. Palsy of the hypoglossal nerve occurred in 3 cases (6%), and facial nerve palsy in 2 patients (4%). Six patients (12%) developed postoperative hematomas in the wound. In all the cases, histopathological examinations confirmed carotid paraganglioma. Conclusions. Cooperation with an otolaryngologist and vascular surgeon during surgery is recommended due to frequent damage to carotid vessels by carotid paragangliomas. Detection of the tumor in the early stages improves surgical treatment outcomes and reduces the number of complications. Regular postoperative check-ups are necessary due to possible occurrences of multiple tumors (Adv Clin Exp Med 2016, 25, 6, 1173-1177).

Carotid body tumors: A report of three cases and current literature review

“…Physical examination, duplex ultrasonography and computed CBTs are slow-growing hypervascular tumors which represent approximately 0.03% of all neoplasms. They appear more common in female gender with male-to-female ratio of 1:1.9 [8]. These tumors were reported to be malignant in 10%, familial in 10%, and bilateral in 10% of sporadic cases, bilaterality can reach 30% in the familial cases [4].…”

“…In addition to these, carotid body hyperplasia should also be remembered; it may develop on account of chronic hypoxia and is primarily described in patients living at high altitudes [6,8].…”

“…Computed tomography and magnetic resonance provide to assess the size, degree and invasiveness of the tumor. Angiographic methods allow the evaluation of the vessels supplying the tumor and preoperative embolization [8,11]. On account of the hypervascularization and proximity to various vascular and nervous structures of these tumors, biopsy as a diagnostic method is contraindicated since it presents a risk of massive hemorrhage and dissemination, and can lead to pseudoaneurysm formation and carotid thrombosis as well [12,13].…”

“…In the year 2008, van der Bogt, et al [16] suggested the craniocaudal dissection technique which would minimize blood loss and thus reduce the risk of perioperative morbidity. Nowadays, surgical excision still remains the gold standard therapeutic modality for the treatment of CBTs [8,17]. Radiotherapy (RT) is an alternative treatment modality which may decrease the tumor size or stop its growth.…”

Head and Neck Paragangliomas—A Genetic Overview

“…Clinical symptoms vary according to the location and size of the tumor. Carotid body tumors typically produce a painless, slow-growing neck mass [ 10 , 11 ] that may eventually cause dysphagia and cranial nerve disorders. In contrast, pulsatile tinnitus and conductive hearing loss are characteristic of tympanic paraganglioma [ 12 ].…”